The Urogynecology Clinic at Aarhus University Hospital treats patients with urinary incontinence, among other conditions. Diagnosing and treating these patients requires data about fluid intake, urination and accidents, which is collected through a fluid and urination form. As part of a Circular Co-Creation project, the Urogynecology Clinic and Journl A/S wanted to explore how a digital platform could be used to collect better data from patients and support the clinicians in the department in their treatment.
The department faced a number of challenges. Today, staff get the necessary PRO data via paper plumbing and questionnaires that the patient must fill out at home on an ongoing basis. However, the reality is that many patients find this cumbersome or forget about it and don't complete the necessary data at all. This means that a large proportion of patients' forms are incomplete and the data quality is low. At the same time, the use of paper forms creates a lot of administrative work for the department's staff. The medical secretary in particular spends a lot of time collecting, documenting and handling patient forms. In addition, the department finds that a significant proportion of patients arrive unprepared for check-ups. This results in visits having to be rescheduled, which is a resource-intensive process for both the department's staff and the patients, and something that could be avoided if the staff had a better opportunity to see if the patients have filled out their plumbing before coming to the department.
During a fluid and urination course, a number of recordings must be made of both fluid intake and urination. This places high demands on the patient's persistence and ability to record consistently and correctly. To ensure the process gets off to the best possible start, the department and Journl developed a series of videos that are shown the first time the patient opens the Journl app.
"The app ensures easy access to verbal, tailored information on filling out the diary and advice on optimal habits. All of which can optimize assessment and treatment for the individual patient."
- Marianne Glavind-Kristensen, Consultant, Urogynecology Clinic
The introductory material also creates a sense of security for the patient, as the department is the direct sender. In this way, patients feel a closer relationship with the department's staff.
"I thought that was fine. It makes it more alive"
- Patient, Urogynecology Clinic, Aarhus University Hospital
A major factor in urinary incontinence is discretion. The main reason patients don't register is because it matters to them that the people around them don't know about their problem. Many patients feel embarrassed about having to fill out plumbing in their daily lives, and some are forced to take time off work on the days they need to register. With the Journl app, patients can record without the experience of others seeing it, as they don't have to do it on a paper form. The app enables a higher level of discretion as the outside world cannot see what they are doing.
"It's easier to hide if you're somewhere. You don't want to sit there with four pages. So it's more discreet"
-Patient, Urogynecology Clinic, Aarhus University Hospital
The app's role in increasing discretion may seem like a trivial factor, but it breaks down a major barrier for patients and improves the registration process.
"I thought it was absolutely fantastic to use it, also because I have used the fluid and water landing chart before"
- Patient, Urogynecology Clinic, Aarhus University Hospital
One of the main hypotheses behind the development of the app was to give patients insight into their own fluid and urination patterns, and that this would motivate and empower them to better manage their problems. Based on the patients' registrations, the app indicates how much the patients drink and urinate each day. This simple feature has proved valuable for many patients, as they can keep track from day to day, and some have already adjusted their fluid intake before their check-up based on the increased knowledge.
"It is positive to have a daily counter of my fluid intake and urination. It gave me an insight into my own fluid pattern"
- Patient, Urogynecology Clinic, Aarhus University Hospital
"The counter was good. It gave insight into my data and balance between fluid I took in and fluid that came out"
- Patient, Urogynecology Clinic, Aarhus University Hospital
Patients who have used Journl App express great satisfaction and they find that the daily use of the app works well and score it highly in a number of parameters:
Through the Journl Platform, the medical secretary can at any time see the status of whether and what the patients have completed in the process. In the event of incompletion, the medical secretary has the opportunity to reach out to patients who are at risk of arriving unprepared. This allows the department and patient to jointly clarify whether the patient can complete the required registrations or whether the check-up should be postponed. In this way, the department can both help patients and greatly reduce wasted time in connection with canceled check-ups.
The results from the pilot test of the Journl Platform at the Urogynecology Clinic show increased patient compliance. During the pilot test, no unprepared patients showed up for check-ups, and the problem of cancellations has therefore completely ceased at the department. The department therefore sees a clear streamlining of administrative tasks as a direct result of using Journl Platform. At the same time, Journl Platform supports direct transfer to the Electronic Patient Journal, thereby replacing the manual scanning of paper forms and saving additional time on unnecessary administrative work.
Nationally, there are an estimated 300,000 people suffering from urinary incontinence, both women and men. The goal is to spread the Journl Platform to all hospitals in Denmark so that we can help and optimize the treatment process on a national level for the benefit of as many people as possible.
